From Bloomberg.com

Women who have had a heart attack benefit from surgery to clear their arteries, though the procedure may harm those with less advanced heart disease, researchers found.

The study, along with earlier research, show that all men with heart attacks or less serious chest pain benefit from the procedure that finds and removes fatty plaque from the arteries. The report in tomorrow’s Journal of the American Medical Association suggests doctors need to be more careful with their female patients when deciding who should get the invasive treatment.

The research, the largest to look at who benefits from the procedure by gender, supports updated guidelines from the American College of Cardiology and the American Heart Association that recommends doctors treat women who have chest pain with heart medicines rather than the surgery. Future studies need to determine why lower-risk women with unstable heart disease may have different results after routine cardiac catheterization, lead author Michelle O’Donoghue said.

“There’s a tremendous need to better understand gender differences in cardiac care,” said O’Donoghue, a researcher at Brigham and Women’s Hospital in Boston and a cardiologist at Massachusetts General Hospital, in a statement today. “Heart disease continues to be the No. 1 killer in women and yet women remain underrepresented in clinical trials.”

Heart Disease Statistics

One in three women have some form of heart disease and women represent almost 53 percent of all deaths from the condition, according to the American Heart Association. The number of women who die from the disease has exceeded men since 1984.

The researchers looked at eight studies covering 3,075 women and 7,075 men who had suffered a heart attack or chest pain and received a surgical procedure or medicine.

The study found that high-risk women with signs and symptoms of a heart attack had a 33 percent reduced risk of dying, having another heart attack or being re-hospitalized with acute coronary syndrome if they underwent artery-clearing surgery before leaving the hospital compared with those patients given therapy of primarily medicine. Acute coronary syndrome is chest pain and other symptoms that occur when the heart doesn’t get enough blood.

In contrast, lower risk women with a type of chest pain called unstable angina, also known as a near heart attack, didn’t appear to benefit from the procedure. The women had a 35 percent greater chance of dying or having a heart attack than those given primarily medicines, a finding that wasn’t statistically significant, the study said.

More Questions

Researchers are unsure why women may have different outcomes than men following the treatment. O’Donoghue said in an interview today that women may be more likely then men to have pre-existing medical conditions such as high blood pressure and diabetes that could put them at higher risk following the procedure. Women also are at higher risk of bleeding, which is associated with worse outcomes.

Women may be more likely as well to have blockages in the tiniest blood vessels of the heart that can’t be seen easily or fixed by cardiac catheterization, she said.

Based on the study findings, the researchers recommend that men and high-risk women with signs and symptoms of a heart attack undergo cardiac catheterization before leaving the hospital. Lower-risk women without evidence of a heart attack should be treated primarily with medicines and undergo the invasive procedure only if they have ongoing chest pain or an abnormal stress test, O’Donoghue said.

From Reuters

People given a blood pressure drug known as a beta blocker to reduce heart risks before surgery were one-third more likely to die within a month and had double the risk of stroke compared with those given a dummy pill, Canadian researchers said on Monday.

The study is the largest, most rigorous to date looking at whether beta blockers do more harm than good in reducing surgery-related risks. Other, smaller studies have had mixed results.

“There is a real potential that beta blockers are causing serious harm in the surgical setting,” said Dr. P.J. Devereaux of McMaster University in Ontario, whose study appears in the journal Lancet.

“If my mother was undergoing surgery and given a beta blocker, I would be extremely upset based on this evidence.”

The findings challenge the long-held belief that giving people a beta blocker before major surgery protects them from heart risks brought on by the stress of the procedure.

Surgery often raises levels of a stress hormone known as catecholamine, which drives up a person’s blood pressure and heart rate. “Beta blockers block the effects of increased catecholamines, so the physiological rationale would say they would be beneficial to people,” Devereaux said in a telephone interview.

He and colleagues set out to test this idea. They studied more than 8,000 patients in 23 countries at 190 hospitals who were undergoing major surgery unrelated to the heart. People in the study had or were at risk for clogged arteries.

STROKE VS HEART ATTACK

Half were given the beta blocker metoprolol, sold by AstraZeneca as Toprol XL, two to four hours before and 30 days after their surgery. The other half got a placebo.

The doctors were looking for heart complications such as heart-related death, non-fatal heart attacks or a heart-stopping event known as cardiac arrest in which the person survived.

While the study did find people given the drug had fewer heart attacks and abnormal heart rhythms, they also were more likely to die or have a stroke.

The researchers said for every 1,000 people with similar risks undergoing non-cardiac surgery, the drug could prevent 15 people from having a heart attack, three from needing a shock to restore a normal heart beat, and seven from developing a type of heart rhythm known as atrial fibrillation.

But eight more people would die, five would have a stroke, 53 percent would have abnormally low blood pressure and 42 percent would have an abnormally slow heart beat.

“This is an important study because, although the beta blocker reduced the number of heart attacks that occurred following surgery, it caused more strokes, thus on balance causing more harm than good,” Peter Weissberg, medical director of the British Heart Foundation, said in a statement.

“This is why it is so important to undertake large clinical trials rather than assuming drugs will only do what is expected of them.”

Devereaux, who first presented his findings at the American Heart Association meeting in November, said he expects the study to stir debate about whether it is still wise to give patients a beta blocker before a major surgery.

“It is telling us something we didn’t realize in the past,” he said.

Many have high percentages of body fat, leaving them prone to heart disease, diabetes

From HealthDay

Despite appearances to the contrary, more than half of normal-weight Americans have a high percentage of body fat. And, like their overweight contemporaries, this makes them susceptible to heart disease, diabetes and other metabolic disorders, a new study says.

Men whose body fat is greater than 20 percent and women whose body fat is greater than 30 percent are suffering from “normal weight obesity,” the study authors said, even though their weight may be normal for their size.

“The prevalence of people with a high amount of body fat despite a normal weight is relatively high,” said lead researcher Dr. Francisco Lopez-Jimenez, a cardiologist with the Mayo Clinic in Rochester, Minn. “Many of these people have metabolic abnormalities.”

These findings should alert doctors that body weight isn’t the only way to protect against health problems caused by excess pounds, Lopez-Jimenez said. Even normal-weight people should be advised to exercise and eat a healthful diet to reduce their level of fat, especially belly fat, he added.

The findings were expected to be presented Tuesday at the American College of Cardiology’s annual meeting, in Chicago.

For the study, Lopez-Jimenez and his colleagues collected data on 2,127 people who participated in the U.S. government’s Third National Health and Nutrition Examination Survey. Specifically, the researchers looked at risk factors for heart disease, diabetes, and metabolic syndrome, a precursor of diabetes.

The researchers found that 61 percent of the participants had levels of body fat that indicated “normal weight obesity.” In addition, Lopez-Jimenez’s group found changes in blood chemistry that can affect heart and metabolic health, including high cholesterol; high levels of leptin, a hormone found in fat and other tissues that’s involved in appetite regulation; and high rates of metabolic syndrome.

Lopez-Jimenez said the study shows that just because your weight may be normal for your size, it doesn’t mean you aren’t at risk for heart disease and diabetes.

“If you have a normal weight, don’t feel that everything is just OK,” Lopez-Jimenez said. “If you have an excess amount of fat, you might have metabolic abnormalities as well,” he said.

One expert agrees that normal body weight is not synonymous with good health.

“Body weight is a very blunt instrument; it is not a reliable gauge of obesity, or health, at the individual level,” said Dr. David L. Katz, director of the Prevention Research Center at Yale University School of Medicine. “For example, a muscular man may have a very high body weight, yet be perfectly fit and healthy. Many people whose body weight is in the normal range are anything but.”

And some people are vulnerable to weight gain in all the wrong places, such as in and around the vital organs of the abdomen, notably the liver, Katz said.

“Even a small amount of extra fat where it matters most can wreak metabolic havoc, increasing risk for diabetes and heart disease, while leaving you with a body weight that looks perfectly innocent,” Katz said. “Excess body fat in the belly is a menace, whatever your weight. This study should sensitize patients and providers alike to this concern.”

From News - Revolution Health

Previous studies of a link between statins, a cholesterol lowering medication, and cognitive decline have produced mixed results. New research suggests that the relationship between statin use and cognitive decline appears even more complex than originally thought.

The study involved 1,146 African Americans aged 70 and older living in Indianapolis whose cognitive status was assessed in 2001 and again in 2004.

The Indianapolis-based researchers found that cognitive decline in people who took statins was less than in those who did not take statins.

However, those who continued to take statins from 2001 to 2004 had greater cognitive decline than those who were taking statins in 2001 but were no longer taking them in 2004. If statin use were directly associated with a reduction in cognitive decline, continuously taking statins would presumably produce the greatest effect.

“The relationship between statin use and cognitive decline is complex and subjected to unknown confounders,” Dr. Stanley Szwast, of Indiana University School of Medicine, and colleagues note in a report in the journal Neurology. “This effect may not be associated with the cholesterol lowering or anti-inflammatory action of statins.”

“We know that taking statin medication can protect against cardiovascular events such as heart attacks by lowering blood cholesterol. The question at hand is what effects do these medications have on brain function. Our study along with others shows promising results but larger controlled studies are needed,” Szwast noted in a statement.

SOURCE: Neurology, November 6, 2007

Study finds it’s linked to higher death risk, but replacing the hormone may not help, experts say

From HealthDay

Men aged 40 or over with low levels of testosterone may be at increased risk of fatal heart attacks or death from any cause, a British study suggests.

In fact, “The magnitude of the effect was very similar to that of [high] cholesterol or blood pressure,” said lead researcher Dr. Kay-Tee Khaw, professor of clinical gerontology at the University of Cambridge School of Clinical Medicine.

However, more work is needed to see whether testosterone supplements should be recommended for men with naturally low levels of the hormone, she said.

“We need to replicate these findings,” Khaw said. “We hope we can entice other investigators to look at testosterone levels and see if these findings are confirmed.”

Her team published the findings in the Nov. 27 issue of Circulation.

The study included more than 11,600 men ages 40 to 79 who were free of known cardiovascular disease and cancer at the start of the trial. It was done because “there have been lots of studies suggesting that low testosterone may not be good for health,” Khaw said. “So, we wanted to see if this could be demonstrated in a large population. Testosterone is hard to measure, the test can be expensive.”

The men were divided into four groups based on their blood testosterone levels.

Those men in the highest quarter of testosterone readings — with at least 19.6 nanomoles of the hormone per liter of blood — had a 41 percent lower risk of dying over 10 years than those in the lowest quarter of testosterone readings — less than 12.5 nanomoles of testosterone per liter of blood.

One major question is whether low testosterone is a risk factor itself or just a marker for other risk factors, said Dr. Victor Montori, associate professor of medicine at the Mayo Clinic in Rochester, Minn. He has done his own studies on testosterone replacement therapy.

“It does not mean that replacing or normalizing levels of testosterone would reverse the outcome,” he said. “There are other hormones in the blood that are related to other risk factors, such as diabetes and hypertension.”

In any case, a testosterone replacement regimen “would not be a walk in the park,” Montori said. “It would be a major intervention.”

According to Dr. Jorge Plutzky, director of the Vascular Disease Prevention Program at Brigham and Women’s Hospital in Boston, the experience of women taking hormone replacement therapy (HRT) shows that hormonal regimens can have their dangers.

Beginning in the 1990s, millions of older American women took HRT, which replaced two female hormones, estrogen and progestin. Early trials had indicated that the therapy might reduce the risk of cardiovascular diseases such as heart attack and stroke in older women.

Instead, the Women’s Health Initiative, a major study released in 2002, found that women taking HRT were at increased incidence of stroke, blood clots and breast cancer, noted Plutzky, who is also a spokesman for the American Cancer Society. HRT prescriptions dropped off precipitously after the study’s release.

So, much more research is needed on the link between testosterone levels and mortality before doctors can recommend the regimen to men, Khaw said. Such studies might provide “insights and better understanding of disease mechanisms, such as how and why testosterone might be related to poorer health through, for example, insulin metabolism, lipid metabolism or inflammation,” she said.